Conventional Phacoemulsification Cataract Surgery Research Articles

Clinic analysis of femtosecond laser-assisted cataract surgery

To evaluate the safety and effectiveness of femtosecond laser-assisted cataract surgery. The interventional case series enrolled 314 eyes undergoing cataract surgery in Xiamen Ophthalmic Center between April and December 2013, patients were randomized to femtosecond laser-assisted cataract surgery(153 eyes) and conventional phacoemulsification cataract surgery(161 eyes). The clincic parameters of preoperation, during operation and postoperation were compared and statistically studied. Quantitative data were analyzed using the analysis of variance, independent t tests. Qualitative datawere analyzed using the crosstabs analysis chi-square test or the Fisher's exact test. The patient's demographics parameters(age, gender, IOP, axial length, mean keratometry, AC depth, Cataract grade) did not differ significantly between groups (P>0.05) . The CDE showing 4.78% (3.18%-8.88%) and EPT showing 14.05 s (10.07-20.85 s) in the laser group were significantly lower than the CDE showing 8.82% (6.01%-19.16%) and EPT showing 23.65 s (18.36-46.96 s) in the conventional group (z=2.30, 2.91; P<0.05) . The relative diameter and circularity in laser-assisted capusulotomies were significantly more accurate (t=2.58, 3.92; P<0.05). The corneal endothelial cell loss showing 73.50 (-69.51-111.03)/mm(2) was significantly lower in the laser group than the loss of 118.06 (53.55-299.03)/mm(2) in the conventional group 1 month postoperatively (z=2.44; P<0.05). Postoperative anterial chamber flare was significantly greater in the conventional group at 1 day of 18.81 (13.32-20.23) ph/ms in laser group, 24.51(16.38-32.18)ph/m in conventional group and at 1 month of 13.01(9.23-16.28) ph/ms in laser group, 18.05(12.37-24.97) ph/ms in conventional group than the laser group (z=2.40, 2.31; P<0.05). There were no severe surgical complications for both groups. The femtosecond laser-assisted cataract surgery was effective and safe. It reduced EPT and CDE during operation, therefore decreased endothelial damage and postoperative anterior chamber inflammation. It also provided more precise and reproducible capsulotomies.

A Comparative Cohort Study of Visual Outcomes in Femtosecond Laser-Assisted versus Phacoemulsification Cataract Surgery

To evaluate visual outcomes after femtosecond laser-assisted cataract surgery (LCS) with phacoemulsification cataract surgery (PCS). Prospective, multicenter, comparative case series. Consecutive patients undergoing femtosecond LCS or PCS with intraocular lens insertion. A total of 1876 eyes of 1238 patients (422 male and 772 female) who underwent cataract surgery between January 2012 and June 2014 were included in the study: 1017 eyes from center A and 859 eyes from center B. Cases underwent clinico-socioeconomic selection. Patients with absolute LCS contraindications were assigned to PCS; otherwise, all patients were offered LCS and elected on the basis of their decision to pay (the out-of-pocket cost for LCS). Demographic and postoperative data were collected to determine differences between groups. Six-month postoperative visual and refractive outcomes. Masked subjective refractions were performed 2 to 6 months postoperatively. There were 988 eyes in the LCS group and 888 eyes in the PCS group. Baseline best-corrected visual acuity (BCVA) was better in LCS compared with PCS (20/44.0 vs. 20/51.5; P < 0.0003). Preoperative surgical refractive aim differed significantly between groups (LCS -0.28 vs. PCS -0.23; P < 0.0001). More patients who received LCS had Toric lenses implanted compared with PCS (47.4% vs. 34.8%; P < 0.0001). Postoperative BCVA was better after LCS (20/24.5 vs. 20/26.4; P = 0.0003) with a greater proportion of LCS cases achieving BCVA >20/30 (LCS 89.7% vs. PCS 84.2%; P = 0.0006) and 20/40 (LCS 96.6% vs. PCS 93.9%; P = 0.0077). However, PCS cases had more letters gained compared with LCS cases (13.5 vs. 12.5 letters; P = 0.0088), reflecting baseline BCVA differences. Mean absolute error was higher in LCS compared with PCS (0.41 diopters [D] vs. 0.35 D; P < 0.0011). The percentage of eyes within 0.5 D of error from preoperative aim refraction was higher in the PCS group (LCS 72.2% vs. PCS 82.6%; P < 0.0001). Femtosecond LCS did not demonstrate clinically meaningful improvements in visual outcomes over conventional PCS.

Femtosecond laser-assisted cataract surgery in residency training.

To examine the current state of femtosecond laser-assisted cataract surgery (FLACS) with a focus on its incorporation into resident surgical education. To date, there are no published data on FLACS in residency training programs. Teaching FLACS concurrently with manual cataract surgery can theoretically allow a trainee to become proficient in both domains and to navigate the complexities and complications of both procedures in a dedicated learning environment. Early reports from completed projects at our institution suggest that incorporating FLACS into residency education is successful and well tolerated. The procedure appears to have a similar safety profile and delivers similar refractive results compared with conventional phacoemulsification cataract surgery, even during the initial surgical learning curve. More research needs to be carried out on the safety profile and outcomes of resident performed FLACS and its ultimate role in trainee education.

Comparison of visual outcome between conventional extracapsular cataract extraction and phacoemulsification cataract surgery

Objectives: To compare visual outcomes in patients who had conventional extracapsular cataract extraction (ECCE) and phacoemulsification for age-related cataract.Materials and Methods: Prospective study comparing the visual outcomes in 360 eyes of 352 patients, 180 of whom were randomized to conventional ECCE and the remaining 180 to phacoemulsification cataract surgery. Visual acuity was assessed on day 1, 1 week, 4 weeks, and 12 weeks postoperatively.Results: In the EECE group, good presenting visual acuity of 6/18 or even better was found in 6%, 31%, 46%, and 69% patients at 1-day, 1-week, 4-week, and 12-week postoperative intervals, respectively. In the phacoemulsification group, visual acuity of 6/18 or even better was achieved in 48%, 78%, 82%, and 89% patients, respectively, at the same postoperative interval as the ECCE group. This difference was statistically significant at all the postoperative intervals.Conclusion: Phacoemulsification achieves better postoperative visual acuity at the early and intermediate postoperative periods. Availability of this technique of cataract extraction will enhance eye care in our various institutions.

Femtosecond laser–assisted cataract surgery versus standard phacoemulsification cataract surgery: Outcomes and safety in more than 4000 cases at a single center

To compare the intraoperative complications and safety of femtosecond laser-assisted cataract surgery and conventional phacoemulsification cataract surgery. Single center. Prospective consecutive comparative cohort case series. Eyes had femtosecond laser-assisted cataract surgery (study group) or phacoemulsification (control group) by 1 of 5 surgeons. The technique comprised manual corneal incisions and capsulorhexis or laser-assisted anterior capsulotomy, lens fragmentation, corneal incisions, phacoemulsification, and intraocular lens implantation. The study group comprised 1852 eyes and the control group, 2228 eyes. Patient demographics were similar between groups. There was a significant improvement in vacuum/docking attempts, surface recognition adjustments, treatment, and vacuum time during the laser procedure in the study group. Anterior capsule tears occurred in 1.84% of eyes in the study group and 0.22% of eyes in the control group (P < .0001). There was no difference in the incidence of anterior capsule tears between the first half and second half of laser-assisted cases. Anterior capsulotomy tags occurred in 1.62% study group eyes. There was no significant difference in posterior capsule tears between the 2 groups (0.43% versus 0.18%). The incidence of significant intraoperative corneal haze and miosis was higher and the effective phacoemulsification time significantly lower in the study group (P < .001). Significant intraoperative complications likely to affect refractive outcomes and patient satisfaction were low overall. The 2 cataract surgery techniques appear to be equally safe. Although anterior capsule tears remain a concern, the safety of femtosecond-assisted cataract surgery in terms of posterior capsule complications was equal to that of phacoemulsification. No author has a financial or proprietary interest in any material or method mentioned.

Visual and refractive outcomes of laser cataract surgery

Femtosecond laser is a promising new technology for the field of cataract surgery. Early studies have investigated many factors including visual outcomes, complication rates, and financial overhead costs. This review analyzes the most recent clinical studies of visual and refractive outcomes in laser cataract surgery, including those that make comparisons to outcomes found in conventional phacoemulsification cataract surgery. As femtosecond laser cataract surgery has only emerged recently, there is limited literature available regarding visual outcomes. Most but not all existing studies showed no statistically significant difference in visual acuity and mean absolute refractive error between laser and conventional cataract surgery cases. The majority of studies examined found visual acuity or refractive outcomes of femtosecond laser to be statistically equivalent to those of conventional phacoemulsification cataract surgery. However, the learning curve involved with laser use may account for these early results, which could potentially improve as better technology and surgical techniques are developed. Further long-term outcomes studies are necessary to more accurately evaluate the benefits and drawbacks of femtosecond laser cataract surgery.

Cost-Effectiveness of Femtosecond Laser-Assisted Cataract Surgery versus Phacoemulsification Cataract Surgery

To perform a comparative cost-effectiveness analysis (CEA) of femtosecond laser-assisted cataract surgery (LCS) and conventional phacoemulsification cataract surgery (PCS) DESIGN: Retrospective CEA using computer-based econometric modeling. Hypothetical cohort of patients undergoing cataract surgery in the better eye based on a review of the current literature and our direct experience using LCS. A cost-effectiveness decision tree model was constructed to analyze the cost-effectiveness of LCS compared with PCS. Complication rates of cataract surgery were obtained from a review of the current literature to complete the cohort of patients and outcomes. This data was incorporated with time trade-off utility values converted from visual acuity outcomes. Improvements in best-corrected visual acuity obtained from the literature were used to calculate the increase in quality-adjusted life-years (QALYs) in a hypothetical cohort between 6 months and 1 year after cataract surgery. This was combined with approximate costs in a cost-utility analysis model to determine the incremental cost-effectiveness ratios (ICERs). Based on the simulated complication rates of PCS and LCS and assuming resultant visual acuity outcome improvement of 5% in uncomplicated cases of LCS, the cost-effectiveness (dollars spent per QALY) gained from LCS was not cost-effective at $92 862 Australian Dollars. The total QALY gain for LCS over PCS was 0.06 units. Multivariate sensitivity analyses revealed that LCS would need to significantly improve visual outcomes and complications rates over PCS, along with a reduction in cost to patient, to improve cost effectiveness. Modeling a best-case scenario of LCS with excellent visual outcomes (100%), a significant reduction in complications (0%) and a significantly reduced cost to patient (of $300) resulted in an ICER of $20 000. Laser cataract surgery, irrespective of potential improvements in visual acuity outcomes and complication rates, is not cost effective at its current cost to patient when compared with cost-effectiveness benchmarks and other medical interventions, including PCS. A significant reduction in the cost to patient (via reduced consumable/click cost) would increase the likelihood of LCS being considered cost effective.

Comparison Between Bimanual Microincisional Cataract Surgery and Conventional Coaxial Phacoemulsification

Purpose: To evaluate corneal endothelial cell changes after conventional coaxial phacoemulsification and bimanual microincision cataract surgery (MICS). Methods: Forty patients were divided into 2 groups, coaxial phacoemulsification (Group 1, n=20), and MICS (Group 2, n=20). To evaluate corneal endothelial cell changes after coaxial phacoemulsification and bimanual MICS, intraoperative phacoemulsification power and volume of intraoperative irrigation solution (balanced salt solution, BSS, Alcon, U.S.A) were measured. Central corneal thickness and endothelial cell count were also evaluated, preoperatively and at 1 week, and 2 months postoperatively. Results: Between the 2 groups, there was no statistically significant difference in intraoperative phacoemulsification power and volume of intraoperative irrigation solution (balanced salt solution, BSS, Alcon, U.S.A.) (p＞0.05). In addition, there was no statistically significant difference between the 2 groups in endothelial cell count and central corneal thickness (p＞0.05). Conclusions: When comparing bimanual MICS and conventional coaxial phacoemulsification, bimanual MICS appears to have similar endothelial cell changes. In conclusion, MICS has the same safety as compared to coaxial phacoemulsification.

Anterior chamber depth and change in axial intraocular lens position after cataract surgery with primary posterior capsulorhexis and posterior optic buttonholing

To compare axial position changes of the intraocular lens (IOL) by measuring anterior chamber depth (ACD) after small-incision cataract surgery with primary posterior continuous curvilinear capsulorhexis (PPCCC) and posterior optic buttonholing (POBH) of the IOL and after conventional cataract surgery with phacoemulsification and in-the-bag IOL implantation. Department of Ophthalmology, Medical University of Vienna, Austria. This prospective comparative study comprised 23 patients (46 eyes) with age-related cataract who had bilateral cataract surgery and implantation of an acrylic IOL (YA-60BB, Hoya). In randomized order, cataract surgery with PPCCC and POBH of the IOL was performed in 1 eye of each patient. In the fellow eyes, conventional phacoemulsification cataract surgery with in-the-bag IOL implantation was performed. The ACD was measured 1 to 2, 6, and 24 hours as well as 7 and 30 days postoperatively using high-resolution partial coherence laser interferometry. A baseline measurement was taken preoperatively in all patients. Ten patients completed 10 to 12 months of follow-up. Postoperatively, the axial IOL position was stable in eyes with PPCCC-POBH (P>.05). In contrast, a significant axial shift of the IOL in the anterior direction was observed in control eyes with in-the-bag IOL implantation (P<.001). The resulting refractive shift was significantly higher in control eyes than in eyes with PPCCC-POBH (P<.001). Combined PPCCC and POBH for cataract surgery significantly reduced postoperative anterior movement of the IOL.